Poor performance status (ECOG ≥3): patient capable of only limited self-care, confined to...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-FITNESS-ECOG-POOR`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Poor performance status (ECOG ≥3): patient capable of only limited self-care, confined to bed/chair >50% of waking hours, or completely disabled. Generally palliative/best-supportive-care intent; cytotoxic therapy at full dose contraindicated. Selective targeted-therapy or steroid debulk may be appropriate as bridge to reassessment.
Clinical direction	de-escalate
Category	fitness-eligibility

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    }
  ],
  "type": "composite_score"
}

Notes

ECOG ≥3 routinely excludes patients from cytotoxic intensification trials. Decision is rarely "no treatment" but rather "treatment proportional to the patient's reserve": prednisolone-only debulk for steroid-responsive disease (DLBCL, ALL) to allow reassessment; rituximab-monotherapy for B-cell indolent disease; ibrutinib-monotherapy in CLL/MCL/WM; aza-monotherapy or BSC in elderly AML. Engages palliative-care consult per NCCN Palliative Care guidelines and ESMO supportive-care guidance. ECOG ≥3 caused by disease itself (e.g. DLBCL with massive disease) may improve dramatically with steroid pre-phase — reassess after 3-7 days.

Used By

Indications

IND-GI-NET-ADVANCED-1L-LANREOTIDE - IND-GI-NET-ADVANCED-1L-LANREOTIDE
IND-PNET-METASTATIC-1L-EVEROLIMUS - IND-PNET-METASTATIC-1L-EVEROLIMUS

Red flag

RF-FRAILTY-AGE-G8-LOW - Geriatric vulnerability flag: age ≥75 AND G8 screening score ≤14 (out of 17 max). Trigger...